NPI | 1457615460 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: DE C2-0013079) |
Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: NJ 25mb09117500) |
2080S0010X Pediatrics, Sports Medicine (Licence: PA OS019939) | |
Enumeration Date | 2012-06-25 |
Last Update Date | 2019-04-29 |